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General NPI Number Information
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NPI Number | 1033317995
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Entity Type | Organization
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Legal Business Name | MAGNOLIA PODIATRY ASSOCIATES PA
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 7727 SOUTHAMPTON TER SUITE 412-F
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City | TAMARAC
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State | FL
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Zip | 33321-9101
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Country | US
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Telephone | 954-721-6010
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Fax |
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Provider Business Mailing Address
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Address Line | 7727 SOUTHAMPTON TER SUITE 412-F
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City | TAMARAC
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State | FL
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Zip | 33321-9101
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Country | US
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Telephone | 954-721-6010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD L WEINER
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Credential | D.P.M.
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Telephone | 954-721-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3137
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License Number State | FL
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